MEDICARE: CENTRO ALTAGRACIA DE FE Y JUSTICIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1144593856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRO ALTAGRACIA DE FE Y JUSTICIA

Provider Business Mailing Address
First Line	:	511 W 164TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-4204
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	511 W 164TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-4204
Country	:	US
Telephone Number	:	212-568-2115
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. RICHARD ESPINAL
Credential	:
Telephone Number	:	212-568-2115

Provider Enumeration Date	:	02/13/2012
Last Update Date	:	02/13/2012

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